Consumer Demands in Healthcare: What Your Members Expect More Than Ever

Jul 25, 2022

Consumer Demands in Healthcare: What Your Members Expect More Than Ever


Consumers change with the world around them and healthcare payors that can keep track of this moving target can improve their ability to enhance customer resolutions, retain members, and gain greater market share. The question is what beliefs, behaviors, and/or expectations have changed within the last few years? Here are some touchstones of transformed consumer demands in healthcare and what other insurers are doing to capitalize on these new necessities.

Consumers Want Convenience

On the surface, this seems like an obvious statement or maybe even old news. Consumers have been conditioned to crave convenience for decades, starting with the expansion of consumer choices and customer-first mindsets in the post-WWII era. However, the pandemic increased the general compulsion for convenience. What started as preference for accessibility upgraded into dependence on easy-to-obtain goods and services as people sheltered at home to reduce the spread of the virus.

Now, we’ve seen eCommerce and omnichannel trends further permeate healthcare services. The U.S. Department of Health and Human Services measured a 63-fold increase in telehealth services across Medicare, rising from 840,000 visits in 2019 to 52.7 million in 2020. Yes, this spike occurred out of necessity, but consumers and providers are accustomed to telehealth when pursuing anything but hands-on care. Even travel insurance are offering travelers telemedicine options to seek medical advice and prescription medication without navigating healthcare in a foreign country.

A 2021 Kaiser Family Foundation report revealed 51% of employers shopped plans between 2020 and 2021, partially to reevaluate their telehealth options for employees. In the same report, the number of firms offering telemedicine in their largest health plan option rose from 69% in 2019 to 95% in 2021. Consumers and employers now expect this as the baseline.

Convenience doesn’t start and stop with telehealth. We’re also seeing consumers open up to new locations for hands-on procedures shy of surgery. A PwC consumer survey revealed half of consumers would consider having wound treatment and stitches or staples removal performed at a pharmacy. Plus, one-third are willing to get an MRI at these types of facilities, if available. In general, there is an opportunity for healthcare payors to gauge what their members and target members characterize as convenient and cost-effective to satisfy those needs before employers or individuals shop for plans elsewhere.

Consumers Want Trust

Trust in institutions and corporations is at a significant cultural low point and payors are not immune from that trend. Even though providers and insurers evolved to offer sufficient and flexible care options during the pandemic, consumers still typically hold a negative opinion about payors. In fact, 59% find the entire process of bill reconciliation stressful, seeing payor interactions as a nightmare in the making.

This isn’t a new phenomenon. Surveys conducted by the Advisory Board in 2019 found that, when consumers are ready to reach out for help in finding healthcare information, only about 14% trusted their health plans. In fact, trust and respect are so important that 60% of consumers in a Huron Consulting Group survey affirmed they would try a new provider if that organization demonstrated greater trustworthiness and consumer respect. Insurers are subject to the same standards – which can drastically reduce the number of referrals or consumer retention rates.

This distrust is not insurmountable. There are some fundamental changes needed in the ways healthcare payors choose to engage with their existing and potential customers.

One example is through greater communication. Consider the explanation of benefits (EoB) mandated by state and federal regulators. Insurance companies are excellent at compliance by this point, but their assumptions about and approaches to consumers may be mismatched with the reality. Often, claims do not tell the full story for their members. When choice is hindered, resentment and dissatisfaction grow among any population.

What might propel healthcare payors into alignment with consumer demands in healthcare is some upcoming revisions to Star Ratings. According to the Centers for Medicare & Medicaid Services (CMS), 57% of Star Ratings will be based on consumer experience by 2023.

Rather than allowing the tail to wag the dog, there is an opportunity for payors to gather data on member preferences, behaviors, and social determinants of healthcare to design services and functions. Surveying customers on their member journey beyond their medical claims can elucidate that information.

Or in the case of some organizations, hiring a care manager can build trust. Whether in-person or remote, a care manager can have direct conversations with members to get to know their needs and direct them to the right services covered by their plans. When people connect with someone they know they can trust, they’re more likely to refer their family, friends, and acquaintances shopping for plans while sticking around themselves.

Consumers Want Transparency

In a consumer survey from Cedar, four out of ten consumers said that when inquiring about a bill, they were dissatisfied with the payor interaction. What is leaving them discontent? At least 36% of consumers struggle with the intelligibility of the explanation of their benefits and 34% want alignment between their bills and explanation of benefits. Moreover, 42% of consumers were eager to see greater transparency about their out-of-pocket expenses.

Confusion and resentment about unexpected medical bills are widespread enough that the federal government is enacting the No Surprises Act. Though consumers will be protected from surprise medical bills and removed from disputes about reimbursement, there’s still an opportunity for healthcare payors to communicate the important details of the billing process.

With these larger segments confused about their bills and explanation of benefits, it is clear payors need to reimagine the ways in which they are educating consumers. The same old approach to EoB leaves enough members scratching their heads and diminish first contact resolution, which can result in lost business to competitors with more straightforward responses to consumer issues. If you’re emulating Warren Buffet’s approach to shareholder letters—writing approachable and easy-to-decipher messages that answer the pressing questions on his audiences’ minds—then you’re wasting time.

Payors that can emulate the Buffett method will speak to consumers in a way that addresses their core challenges. Across omnichannel communication, there is a chance to ask consumers what they want to know in a direct manner and address them in a way that clarifies questions about billing, coverage, and benefits scope.

Staying Attuned to Healthcare Consumers

As the pandemic proved, windfall events can reshape or accelerate trends that characterize the healthcare industry, making immersion in the latest technology equally important. For example, digital transformations in healthcare payor organizations increased the accessibility and cohesion of data analysis in these instances, allowing stakeholders to understand consumer healthcare demands and preferences in real time.

As long as you strive to maintain a technological cutting edge and create appropriate use cases to leverage these tools, you won’t miss out on insight that can protect your revenue stream, increase referrals, and boost your profit in an evolving market.

Are you eager to stay attuned to consumer demands in healthcare and other current topics? Check out our Healthcare Payor insights page for more perspectives on your top challenges.



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